HomeMy WebLinkAboutHomestead_TrautvetterFORM TIC 10 1979 To Be HIM in Ouplicale
Prescribed By State Board of Tax Commissioners
CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 19_7_
�!n SE BACK FOR FILING INSTRUCTIONS 01001 j '00
(We) �OV�• �ertify that on the 1st day of
arch, 19 I, (We) occupied as our principal Kace of residence the following described real property for
which a Homestead Property Tax Credit is hereby being claimed:
I, (We) ❑ owned
❑ are buying under contract
❑ have a beneficial inter i
n taxpayer
Property Description in- .
County Township
i
Taxing District (City, Town, Township):
Parcel Number
or legal description shoA on tax statement:
/IV f-� -. � • .sa /sue
If buying on contract: Owners name (lee simple owneo
Contract recorded in Recorders Office
Record No
If any portion of the residential structure or the land, not exceeding one (1) acre that immediately surrounds that
structure is used to produce income, describe the use and portion of the property utilized to produce income
Any other counties in which individual owns or is buying real property:
hereby certify the above statement is true, correct and complete.
M
11
County Township
Stale and Zip Cone
4/7660
Individual either owns or is buying under a contract that provides he is to pay the property taxes
on the residence, or has a beneficial interest in the taxpayer.
- FOR ASSESSOR'S USE ONLY -
Land not exceeding 1 (one) acre immediately
surrounding residential improvements
Other Land
Total Land FILED
Residential Improvements Dwelling
.11 IN 11 1919 Garage
o a
yst `T n�`
Other Improvements ff `F AUDITOR
Tot I Improvements - Line (6) plus (7) equals (8)
1 -6,by certify the above is true. correo and completE
Signarme of Assessor
Approved
True Cash Assessed Homestead
Value Valuation Valuation
191 D
(3) //00 —°
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Date: